Methodist Medical Center Foundation: Ralph Lillard

METHODIST MEDICAL CENTER ORAL HISTORY:
DR. RALPH LILLARD
Interviewed by William (Bill) J. Wilcox, Jr.
August 27, 2008
MR. WILCOX: This is Bill Wilcox and it is August 27th, about 10am, and I am interviewing Ralph Lillard who for 32 years was one of the top administrators of the hospital here in Oak Ridge. Ralph has kindly done some good homework preparing for this interview outlining highlights of his years with the hospital. I will attach his notes, and refer to them from time to time as we listen to Ralph this morning. Ralph, thank you so much for coming in to chat. We have completed the release form. You have done a wonderful job of outlining your timeline and key events and I would like to let you go through them and tell us what you can about your times here at the hospital. First Ralph, let me get information about when you came first to the hospital here in Oak Ridge and who hired you and what was your first job when you came?
DR. LILLARD: I’m glad to be here, thank you for the invitation; it represents a significant part of my life’s work, being here at Methodist from 1964 to 1996. I first came to Methodist as an administrative resident from George Washington University, Washington, D.C. on a two year residency and my mentor was ORHMC [Oak Ridge Hospital of the Methodist Church] Administrator Paul Bjork. He was on the mentors list from GW and I selected Oak Ridge because I came from a small town growing up and I looked at that list and saw Oak Ridge was the only small town on the list! So I began to think that I might want to interview here so that’s how I got here.
MR. WILCOX: What was your hometown?
DR. LILLARD: Siloam Springs, Arkansas, a long way’s away. That is how I came, I spent two years being an administrative resident and writing a lot of reports, doing a lot of things, working myself through the rotation of every department of the hospital. One of the special early projects that stick out is the conversion of the old West Mall “D” wing to a nursing home. That was an interesting project.
MR. WILCOX: That was in the mid sixty’s?
DR. LILLARD: I believe it was between 1964 and 1966.
MR. WILCOX: Why did we renovate that wing, the West Mall wing?
DR. LILLARD: Well, the wing was a part of the old “D”-wing of the original hospital, and it was standing idle and the Board, which you may or may not have been a member of then (WJW- I was), decided to convert that wing to a nursing home facility, to be part of the core business of the hospital.
MR. WILCOX: What else do you remember about those years? Were you involved in the big strike 1966?
DR. LILLARD: Yes. I think about these years in five ways (see his attached notes) …..
1. Vision
2. Facility
3. Medical staff
4. Services
5. Major issues
I used this in my notes as the outline of what I remember in various periods (see attached) and certainly some of the dates need to be confirmed by the corporate records. In those early years under Vision I think of three things:
#1. Financial survival. The community received a nice new hospital in 1959, but no cash that went with it and so the survival issue was how you have enough cash flow, pay the payroll, and do things that need to be done to operate a 220+/- bed hospital. It was a significant matter and so the vision under that would be “How do we survive next year?” A lot of time, effort and energy was spent trying to determine that.
#2. To maintain the hospital services for Oak Ridge and part of Anderson County and Roane County. The service area in the mid 1960s was limited to Oak Ridge in terms of vision and our part of two counties, so it was a very limited market.
#3. Secure financing for the Medical Arts building that had been built but not fully completed. I remember making trips to B.C.Zigler Co. in Wisconsin and securing some bonds. Some taxable bonds that we sold and we were lucky to do that in order to pay for the Medical Arts building eventually and also to occupy it all to provide space that the physicians needed desperately.
Under Facility, as I noted, we had a 220 bed general-acute care hospital built by the federal government and given to Oak Ridge in 1959. My recall there were about 23 physicians here when I got here maybe upwards to 30 but no more than 30. The services were those of a general-acute care hospital service and the major issue you just pointed out then was a 51 day labor outage in 1966 with the BSEIU [Building Service Employees International Union].
MR. WILCOX: I was on the Board then and it for sure was the major issue for the Board that year!
DR. LILLARD: It made a lasting impression on me in terms in how you relate to people and develop trust. That lesson was a very fundamental learning that afterward was incorporated in everything we did which we’ll see over the next 30 years. That’s all that period of time, do you want me to run to the next time?
MR. WILCOX: Yes, please do. The next key period of time was what?
DR. LILLARD: 1967, and the reason for that is because that was the year the new administrator came to ORHMC - that’s right, Paul Bjork left, Marshall Whisnant came in. He became not the administrator but the President and CEO, so we changed corporate titles and his vision and mine too. He was the principal person that was, first, to build an organization based on “New Business Principles and Values”: and second, to improve the hospital services and third, to recruit new medical staff members. That was the vision for that period of time.
MR. WILCOX: Grow the medical staff?
DR. LILLARD: Yes, and the hospital services.
MR. WILCOX: How about the service area?
Well, that had not been addressed yet. I’ll get to that, but first we were just trying to replace some of the medical staff that were nearing retirement. We did that and then we tried to improve not only hospital services but to envision what medical staff needs would be. There were no changes in terms of facilities, no major changes in medical staff although the records may reflect there were some, but I’m not going deal with that now. But the second major issue other than recruiting, the new President and CEO was building trust between the management and hospital personnel, trying to heal the many scars were left because of the labor outage.
MR. WILCOX: How about building the support of the community, was that something that you all tackled then or did it come later?
DR. LILLARD: We tackled it every day.
MR. WILCOX: Because there were a lot of scars left in the community?
DR. LILLARD: Absolutely.
MR. WILCOX: As a result of the labor outage?
DR. LILLARD: Yes, there certainly were. There were lots of ways that these issues were addressed; like we went out and became integral parts of various community activities to explain the hospital story and also do work in behalf of the community. We also addressed making sure that the community leaders were on the Hospital Board to bring in every aspect of the community…
MR. WILCOX: You mean diversified the Board from what it had been?
DR. LILLARD: Yes, that is correct, so the policies of running the hospital would be reflected in that diversification.
MR. WILCOX: When I look back, Ralph, I see those years 1967 and shortly then after, as years when we really did change the hospital image in the eyes of the community and the staff of the hospital. I give you and Marshall tremendous credit for that.
DR. LILLARD: Well there was a lot to do because the scarring, started from its inception in the referendum.
MR. WILCOX: It started back then?
DR. LILLARD: There was a scarring there.
MR. WILCOX: It was exacerbated by the strike?
DR. LILLARD: The strike, you are correct and then just the fact that we needed to heal and how we were going to go about doing that was a task that was very significant.
MR. WILCOX: What about the administrative staff in 1967? That time frame? Was the top management primarily you and Marshall?
DR. LILLARD: It was. I can’t remember the Director of Nursing then, I think Frances McCallum may have come and gone. It may have been Guthrie Davidson or Shirley Belvins, one of those two, but I can’t remember…the files will reflect who that was. Certainly, they were a vital part but the next big part to answer your question, the question you had, was the coming and recruitment of a Nurse Executive to manage the Nursing Services. That was the major issue of 1971. We wanted a “world class person” because one of the things that the labor outage reflected was that we needed to put a higher emphasis on quality patient care, and we needed to make sure that nurses had an education program here internally, and we needed greater expertise from the management point of view. We researched the nation and very helpful to that research was the Tennessee Nurses Association (TNA) executive director in Nashville Mrs. Rebecca Culpepper, who suggested some names to me -- and one of those names was Elizabeth Cantwell, who was in New York City.
MR. WILCOX: My goodness. Well, Ralph I have never heard that story. So Betty came from New York?
DR. LILLARD: Yes, Rebecca Culpepper suggested her personally because she had Betty talk on various seminars. Betty worked for the American Nurses Association (ANA) and lived in New York. To make a long story short, we interviewed and Betty decided to come to Oak Ridge, TN. What a blessing that was for our community and for the hospital.
MR. WILCOX: Amen to that! When was this?
DR. LILLARD: Betty’s first day was January 2, 1971.
MR. WILCOX: You still remember?
DR. LILLARD: It was a big day. We celebrated because our vision was that we had to improve the quality of healthcare services at the hospital and we knew that Betty would be an integral part of that. Second thing was at that time we were involved with improving the business processes and the old electronic data processing. Punch cards were flying everywhere and those card sorters were going all night. We were getting bigger, more complex, we needed information on a faster basis and so we were trying to incorporate some efficiencies in how we took care of our business side. The next need in terms of vision was to recruit new physician specialties, which we would continue to do. In 1970/1971, we added some major new facilities. We put in a new first class physical therapy department and brought in Don Russell. His wife Helen Russell was Secretary to Paul Bjork and then to Marshall. Don helped many, many folks and was a highly popular person. But he ran the physical therapy department starting in 1970.
MR. WILCOX: That was a new venture for the hospital?
DR. LILLARD: We had had a Physical Therapy Department, but it was not the modern day updated Physical Therapy Department we wanted to have.
MR. WILCOX: But Don turned that around?
DR. LILLARD: Melvin Overton had been the head of our Physical Therapy Department and he retired. So when he retired we consulted with Don and he helped us facilitate and design the new PT Department and that came online in 1970. Also at that time, there was a new business office, new admitting, new administrative office, and a new dietary department that came on line in 1970. My records show we are still continuing to recruit physicians, but I would just have to go to the files to see who those were.
MR. WILCOX: But the number of physicians continued to successfully increase?
DR. LILLARD: Yes, and I’ll get to the numbers in a little while but in that particular year 1970 we were continually recruiting new physicians always based on need. Now as part of the new services that year 1970, we opened our first Coronary Care Unit (CCU). That was a moment in which the community was proud, we had a big open house and brought in a new clinical specialist we had never had before and indeed our move toward high quality care service was on the road uphill.
MR. WILCOX: Ralph, if I may interrupt, you mentioned Don Russell, and how helpful he was in revitalizing our Physical Therapy Department, but I wonder if you could say another word about Helen Russell before we move on?
DR. LILLARD: Yes, Helen Russell was, the day I came in 1964, one of the first two or three people I met. Helen Russell was the secretary or administrative assistant to Paul Bjork and she took care of me and kept me straight, She knew all the rules and she knew when I was suppose to do this or that and the other in terms of structure. She called me in the morning and she let me know that I was not here on time! Or that I was doing something I didn’t need to be doing. And as time went along she served as my secretary also. But unfortunately Helen had a disabling stroke.
MR. WILCOX: That was tragic, Helen was great lady.
DR. LILLARD: I still to this day see Helen and Don frequently and we just love them. I don’t know what more to say about them.
MR. WILCOX: They are great people. I just wanted to get that on the record that Helen not only nurtured you, but I can attest that she also nurtured the Board. Paul was always very busy, but Helen was the one who could answer my questions.
DR. LILLARD: Absolutely. What a wonderful contribution both Helen and Don Russell made to this hospital. In 1973, I saw no change in the vision and the facilities but the medical staff we had recruited involved some new specialties, one was Dermatology, another was Endocrinology, others were Gastroenterology, Nephrology, Hematology, Oral Surgery, Otolaryngology, Pulmonary, Neurology, and Allergy.
MR. WILCOX: How in the world did you get all those specialists?
DR. LILLARD: We worked at it, day and night, seven days a week. We knew that having the physicians available to serve the patients was the lead strategy for us. If we did not have them, the people folks wanted to have take care of them when they were sick, we would not have a full service hospital. So what we wanted to guarantee the physicians and the patients was that once they got here they would have quality care. It was a good match. New services during that particular year included our contracting for full time physician coverage in the Emergency Department. That was a big thing.
MR. WILCOX: I remember that as a major change.
DR. LILLARD: It was a major thing because we had no money. We fortunately were able to negotiate a contract with Dr. Herschell King and he took the job at risk. The medical staff supported him, and they very much wanted to stop answering calls to go from their homes or offices to the ER. They wanted somebody to fully staff the Emergency Room, a qualified physician so then they could take calls based on his referrals, and they would be called a lot less than if nurses were running ER. Dr. King saw the patient first and took care of them unless it was obvious that someone else was needed.
MR. WILCOX: That was a very different philosophy, isn’t it? Prior to that, a nurse would call each of the specialties?
DR. LILLARD: The nurse would make the initial assessment and call the physician, this was part of our quality initiative. Now a physician would make the initial assessment and call whatever specialist was necessary.
MR. WILCOX: He would take care of a lot of calls that I wouldn’t say were trivial but were of a lower level of need calls?.
DR. LILLARD: Sure, and the patient could be taken care of much more quickly. It was a process of improving the care.
MR. WILCOX: You improved the care of the patients but you also helped the relationships with the medical staff?
DR. LILLARD: It was more than helping a relationship. The physicians had gotten to a point they could not do both. They could not practice their specialty because of the volume and run back and forth to the ER. This was a good thing for all concerned. It was one of those things, Bill, that was a win/win, the patient won, the hospital won, the physician won, it was a good thing. Some of the major issues in 1973 were to determine the need for new beds, for a new Radiology, Surgery and Outpatient facility as well as for new parking capacity. Also we were getting to the point where we needed to recruit a new executive to manage our financial services. As you note on the chart we accomplished that by finding and hiring someone who knew the hospital well (he was born in the hospital!) Richard Stooksbury. We knew him because he was with Ernst & Ernst, a major accounting firm and our hospital auditor. He was the primary person responsible for our audits and we knew he knew the hospital well. He was a man of integrity and he was very bright person. We were successful in recruiting him, and what an advantage we had then at the hospital because he was an outstanding person. The next year I would like to look at is 1976 and the principal focus then was on facilities. The vision stayed the same and the medical staff. I’m not going to address the staff or the services, but as to facilities we completed our study, and decided now we had to provide additional facilities because our volume was increasing so we added a new patient care wing in 1976. It had four floors and when it opened, we had around 268 beds.
MR. WILCOX: Ralph, could I ask you how in the world did we pay for that?
DR. LILLARD: The new beds?
MR. WILCOX: Yes.
DR. LILLARD: We sold bonds.
MR. WILCOX: Again?
DR. LILLARD: Well the first time through B.C.Zigler they were taxable bonds. I need to be checked on this but I am fairly certain that these last ones were tax free bonds sold through the Health and Education Board.
MR. WILCOX: And the State?
DR. LILLARD: Yes, that is correct. At that time there was a Health & Education Board both in Oak Ridge and one in the county. I believe these were done through the Anderson County Health & Education Board. Patients from our own service area pretty much bought the bonds which was good for us because they then had a stake in the success of the hospital.
MR. WILCOX: Another win/win?
DR. LILLARD: Yes, the interesting thing about the new beds in the General Care wing was that they utilized a new concept of “decentralized nursing.” We did a nation-wide study and decided we wanted to do this new concept, the reason was that everything would then be closer to the patient. The chart would be in the patient’s room, the principal sterile supplies would be in the patient’s room, so the nurse would be traveling to the patient as well as the doctor would be making rounds as opposed to everybody centralized in one nursing station. It was a different concept, a very, very significant change at the time.
MR. WILCOX: Did the staff buy into it?
DR. LILLARD: It was a struggle. We had great clinical leaders led by Ms. Betty Cantwell, who really believed that the patient care would improve in that way. There was some resistance as is with every change, but over time it got to be something that many others came to look at and copied over the country.
MR. WILCOX: Knoxville too?
DR. LILLARD: Not sure Knoxville, but many places in the country did. The ground floor of this facility change included Intensive Care, Coronary Care, Surgery, Recovery Room and Emergency Room. That too was a significant change for us. Then we began to think about a major issue in 1976, “What is the new mission and vision; what should it be for Methodist?” In 1984, the next date I would like to consider because it was then that we came forward with what the new vision was –“To be the leader in meeting the healthcare needs of all the people in our region.” That bigger region was Anderson, Roane, Morgan, Campbell and Scott counties which was approximately 185,000 people.
MR. WILCOX: Was that a new concept at that time, the mission, was that the time when we expanded the service area?
DR. LILLARD: Yes it was. I noted initially that Oak Ridge Hospital was focused on Oak Ridge and part of Roane and part of Anderson Counties, that was the market. That was the service area.
MR. WILCOX: Really a local hospital?
DR. LILLARD: Really local. As time went on, we began to implement the vision and it came forward officially and approved by the Board in 1984 that we wanted to be the leader of a 5-county market.
MR. WILCOX: Were there objections to this taking of the 5-county market by other area hospitals?
DR. LILLARD: Sure, but you know we were competing against ourselves in terms of getting better. We were not necessarily competing against other people. We just wanted to get better. I’ve got a quote here from Marshall Whisnant relative to that fact. Marshall said, “Patients were having to drive past Oak Ridge for healthcare offered only in Knoxville. They wanted more healthcare options closer to home”. We determined it was our mission to provide those options. So that was what we were doing. So in 1985 was the next benchmark that I have. Then our focus was not on Vision because we just established that, or on Facilities, but at that time on the Medical Staff. At that time we were recruiting a lot of family practitioners because we found out that in order to “feed” all these specialists there needs to a strong primary care base. So we formed a couple of groups, one in 1985 and one in 1986. In 1985 we formed “East Tennessee Family Clinics,” and that was where we tried to provide support to family practitioners by way of office management, by way of recruiting, and by other things that would make their practice more successful. We gave them databases so they could do their own quality assurance within their practices, and we became, in effect, a very supportive alliance with the family practitioners.
MR. WILCOX: You said very clearly, clinics, plural. I know about one family clinic here in Oak Ridge, Where were the others?
DR. LILLARD: The second one if I recall correctly was in Clinton and the next one was in Powell and the next one I believe was in Lake City or Oliver Springs, then one in Morgan County. So we had many clinics. Now the clinics I talked about were not only those built in 1985, but there were a progression over time – all of them under East Tennessee Family Clinics. In addition to that we formed another company called Tennessee Medical Management in 1986 and that was to provide similar services to people outside our market. At that time, the Norris Family Clinic was outside our market and we related to them in a different way. They came under the TMM model, so that we would want the McNeeley’s (the father and the two sons at the time) to refer to our specialists if at all possible, so we helped them with their practices -- but they had a choice, we didn’t mandate anything -- they had the choice to refer anywhere they wanted to.
MR. WILCOX: But you gave them great support?
DR. LILLARD: We gave them great support so that it made it easy for them to refer to us and to our specialists. If they choose to do that, it was good. In terms of major issues for 1985, we needed to provide both CV Surgery and Neurosurgery for what we then called the circle of care to be complete.
MR. WILCOX: CV?
DR. LILLARD: I am sorry, cardiovascular surgery and neurosurgery, because we wanted the circle of care, we called it at that time, to be complete – that’s when you could get everything at Oak Ridge that you could go to Knoxville and get. We had equal to or better services. That’s what we called completing the Circle of Care. We successfully recruited those in 1990. Let me back up to pick up a very important event in 1985. We recruited a COO to manage the hospital on a day to day basis, and he was George Matthews.
MR. WILCOX: Was this because you were now getting so involved in the regional work?
DR. LILLARD: We became regional so that we evolved into the Methodist Healthcare System and we had two divisions. One division was a for-profit division which had things like Healthcom under it. Under Healthcom was real estate and Outpatient services other than on the Methodist campus and then it had TMM, which we described a while ago and we had a relationship, a half ownership/relationship in an insurance company with Ft. Sanders called PHP. Those were taxable. The not-for-profit was MMC, the hospital and the hospital foundation and we had two divisions and so we had a holding company that sits on top and that was how that went.
MR. WILCOX: Ralph, you just mentioned the word foundation, do you remember why or when that started?
DR. LILLARD: No, I would have to go to the files to see. I do know, it started initially because we had some significant gifts that we ran through the hospital and that was fine since we were a 501(c)3 organization. It worked fine. One of the gifts was from Paul Spray, Paul and Louise Spray, someone that we all know and love, but we had some other great, nice gifts too and we decided we needed somebody to focus on getting more of that kind of giving. They just came because people believed in us and they just came about. We decided to put some focus on it and we did form a foundation and ….
MR. WILCOX: This would have been roughly in the 1995 or so??
DR. LILLARD: I am guessing 1990, but I am not positive.
MR. WILCOX: Who was the first foundation director?
DR. LILLARD: The first Director was Ken Menifee. He grew up in Oak Ridge and his family lived here,
MR. WILCOX: You were telling about this new recruiting of the new COO.
DR. LILLARD: Yes, that was George Matthews.
MR. WILCOX: I remember George’s coming then just as an Oak Ridge citizen reading the newspaper. I read that you were hiring a COO but didn’t really appreciate until your nice description, that his hiring was because the top management, you, Marshall, Stooksbury, were pretty well so absorbed with lots of ventures outside Oak Ridge, the regional impact that the hospital had?
DR. LILLARD: We were concerned with the strategy. Excuse me, let me back up, we were concerned about the vision, the mission, the values, the culture and how we strategically implemented those in the organization.
MR. WILCOX: But at the same time you were very concerned to make sure about patient care?
DR. LILLARD: The core hospital, day-to-day operations needed professional attention and we brought in George Matthews. What a wonderful find that was for us. I had known George for a long time.
MR. WILCOX: Had he come from within the system here?
DR. LILLARD: I knew him initially at Baptist in Knoxville. He left Baptist in Knoxville and went to ParkWest and then he went to UT-Martin in Martin, Tennessee, an HCA [Hospital Corporation of America] hospital. Anyway we were keeping up with him, he was a wonderful man, good values, good match for us, so we made contact with George and to make a long story short he came in 1985 and had a wonderful career here at Methodist. In 1990 the vision was that in addition to being the Healthcare leader, Methodist should also provide high quality, low cost care that could be measured, not just saying we had it, but we wanted to measure it.
MR. WILCOX: Metrics?
DR. LILLARD: Yes, for the people in the five county area. I’ll show you in a minute how that played out. But that was the vision. We wanted to be able to do that. The value desired at that time was improving the quality (measured), improving the service (measured), and lowering the cost at the same time. You improve the quality, you improve the service, and you lower the cost concurrently. That was our definition of value. Facility-wise, a new CV and new neurosurgery suites were completed in 1988 to 1990 time frame. The new fifth floor to the Patient Care services was completed as well as Administrative Business offices, Outpatient Services and we renovated the dietary, the lab and the pharmacy.
MR. WILCOX: Major renovations?
DR. LILLARD: Yes and the new hospital physician’s office building which was called Physicians Plaza was built and the interesting part about that, we talked about real estate earlier. We had been buying real estate through another entity for the last three or four years. Such Oak Ridge “landmarks” as the Snow White, Kittrell’s paint, and Mill’s florist were part of that as well as Dr. J. D. Johnson and the dental office and some other people. We quietly bought them over time and tore them down so we could turn the hospital front door around to face the Turnpike in 1990. When we opened these new facilities the hospital could be accessed from the Oak Ridge Turnpike as opposed to just Tennessee Avenue, a major change. That was a major change in our image.
MR. WILCOX: But you said “quietly” Ralph, weren’t there some people who didn’t like the destruction of the “priceless” Snow White - not a very quiet operation?
DR. LILLARD: I could tell you some stories, but that was an interesting time.
MR. WILCOX: Of course Oak Ridgers’ love to express themselves and didn’t hesitate… how about Cheyenne and Charlotte Hall, was that later?
DR. LILLARD: Yes, much later. The medical staff we were successful in recruiting CV and neurosurgeons and that was great. In terms of services, we did implement those two new services. That was a big thing and a whole different story about cardiovascular surgery and how that all came about. Baptist of Knoxville mentored us and we did parallel services with them for a while for six months before we were weaned away. They were very helpful to helping us get CV services here and in a quality way. We also started the process to implement a total quality approach to management based on W. Edwards Deming’s philosophy.
MR. WILCOX: What drove that?
DR. LILLARD: What?
MR. WILCOX: The idea of trying Deming’s philosophy of quality, quality control management.
DR. LILLARD: We called that process Quality Together (QT), we had used Management by Objectives for all these years. We had been going around and watching other, what we considered to be better performers than we, across the country and they had some processes that we did not have. There was a local firm here in Knoxville (WJW-Qual-Pro on Pellissippi Parkway) whose leader was one of the Deming disciples. We the Board and the management and the medical staff leadership decided to take a week off and go and listen to that disciple and let him let us know all about Deming. We came home and made a commitment that that was what we were going to do here. Because we felt like in terms of quality and terms of measuring our quality we didn’t know how to do it unless we went this direction.
MR. WILCOX: I am fascinated by the fact that you and Marshall and the others were looking at other hospitals in the country trying to see if there were “best practices” somewhere else that could be instituted here. Who on the management team was really doing this looking at the other hospitals. Was it you or Marshall or. . .?
DR. LILLARD: Marshall was the lead person in that. He would identify some areas and then depending on the area identified decided who went to follow up. If it was a financial area or if it was business efficiency, Richard Stooksbury went. If it was Nursing, Betty and some of the clinical specialists went. If it was organizational, I was the guy that had to implement those things. But in terms of Quality Together it was all of us. We stopped and we decided to learn together.
MR. WILCOX: The team went together?
DR. LILLARD: Even including the Board because unless the Board was completely understanding and if it isn’t from the top down it will not work.
MR. WILCOX: One other question I had…. You mentioned the new Physicians Plaza building which of course the community saw, all we saw from the outside was a major building addition. Was that primarily a tool to help in your recruitment of other new physicians or was it a service that provided space for the physicians we already had?
DR. LILLARD: Both. Those were the primary reasons, but there was another reason, that was image. We wanted our image to change. The image we wanted was that of a Medical Center, a Regional Medical Center, not just a local hospital. It looked different, we began to put together a campus, and the campus now extended from New York Avenue (which I know some great friends that live on New York Avenue. Right, Bill). So it is extended from New York Avenue all the way (east) up to past the Ridgeview Mental Health Center. Major issues in 1990 was to apply the QT process throughout the organization, the Board of Directors, the medical staff, and all hospital personnel, and that required a culture change. That was a significant process that we did.
MR. WILCOX: A culture change?
DR. LILLARD: It took several years to accomplish. In addition to that, Betty Cantwell retired in 1990. What a contribution and what a lady she was!
MR. WILCOX: Ralph, if you will hold on just a minute I have to change my tape. OK, I have turned the tape.
DR. LILLARD: I want to talk a little bit about the guiding principles of the QT program because our mission statement as you know stayed the same. That was, we wanted to be the leader in meeting the healthcare needs of all people in our region, the five counties. But once we embarked upon the QT program -- not program, excuse me – the Quality Together process, we needed some guiding principles and we went through the organization and we looked at it from inside out and we had lots of sessions with lots of employees and we say, what is at our “core.” What really drives us? What really will bring trust and a unity of purpose to us? We settled on four things. One was a quality policy; we wanted quality care and products. Next one was a service policy; because we wanted to satisfy the customer. The third one was a people policy -- we wanted to promote teamwork and mutual trust. The last one was a resource policy; one that allocated all of our resources wisely. Those were the guiding principles of the “Quality Together” effort.
MR. WILCOX: Ralph, when you say quality together and “QT” process I used to hear so often about QC so for the transcriber I want to be sure we are talking QT. Quality Together what does that mean?
DR. LILLARD: That means all of us in this organization from the Board, every employee, all of us are unified in how we were going to approach our work. We were going to utilize these four guiding principles to do that. We were going to not just do it but measure it so we know we’ve done it - and that’s what we set out to do.
MR. WILCOX: Was that a hard sell for the staff? How long did it take?
DR. LILLARD: It wasn’t an authoritative commitment. It was an appeal in which we reached out to the people, because the people felt the excitement of what Methodist was doing. People, including the board, the medical staff and all the personnel all felt we needed to do something that unified us that we could totally have faith in one another to bring us up to the next level. I used to, not only I but Marshall and the whole team, used to go around and one of the measurements was that we could say that 85% of the people (employees) that we could just randomly walk in and ask them what the mission, the vision and the guiding principles at Methodist was, we would get an 85% plus response. They knew, they would rattle it off. Eventually that changed the culture because that was who we were and that was how we thought. That is how we measured our performance. When you go down to the Dietary Department and you see the guy washing the pots and pans has a process quality “Run Chart” on top of his pot sink, it feels good because you could not have that without educating the people on the process. When the pot washer knows how to do a “Run Chart” (displays process performance over time), it makes everyone feel good because we know the employee has been given the “tools” not only to measure his own work but also to continually improve it. 1995 was the next benchmark I would like to look at. The vision was the same, the facilities were basically the same but the medical staff in 1993, the family practice physicians, there were about 25 of them who became “office based.” They decided….
MR. WILCOX: What does that mean?
DR. LILLARD: It meant they didn’t want to go to the Emergency Room anymore or admit patients to and care for them in the hospital. Either one. We had so many family practice physicians in so many different locations, which I defined earlier. It was very difficult for them in Norris, in Oliver Springs, Morgan County and Powell to come and attend their patients in the Emergency Room so we had full time Emergency Room physicians, but then when it came time for admission to the hospital for primary care that became a big problem. The same thing again happened that happened back when we got Emergency Room physicians so we formed this new group of physicians called Methodist Medical Group (MMG). It still exists today, where we have full time physicians in the hospital who admit and take care of folks in the hospital. That was the major thing in 1993.
MR. WILCOX: Wasn’t Dr. Richard Dew one of the first ones?
DR. LILLARD: Yes, he was. Richard Dew was one of the point people, he and Dr. Garton were the two people that implemented that. You know if we had not had a close working relationship with the physicians that would have been difficult to do but as it turned out the medical staff in general was very supportive of this move. The hospital was very supportive of it. We engaged “Team Health” who ran our Emergency Department at that time, John Mincy, M.D. was president or the person who looked after the Emergency Department. It was an extension of our Emergency Department and it worked extremely well.
MR. WILCOX: As I remember it though from the stand point of the patient it was sort of a bummer to not have my own doctor attending me when I had to go to the hospital as a patient and have to meet a brand new person.
DR. LILLARD: That was resolved over time. Any change…any time you make a change like that communication helps. In the doctor’s office when they began to tell all their patients how this process worked, it helped. And here’s how it worked. The patient presents themselves in the doctor’s office at which time he would tell them if they needed admission and he would make arrangements, or he’d let us know that within 24 hours of that time they were to be admitted to the hospital. Then the family doc would get a progress sheet faxed back to his office so there was no competition between the MMG hospital doc’s and the referring doc’s because MMG doc’s saw no office-based patients. So all the medical issues they found in MMC, how their treatment went, the outcomes, and how they needed to be followed up was all sent back immediately so it could be incorporated in their chart in the home physician’s office. All that got done and over time the patient saw it was a “hand and glove process.” The major issue in 1995 was that Marshall Whisnant retired and it created the need to recruit or appoint a new president/CEO and as it turned out, I was the person the Board decided to hire. In 1996, I did become the president and CEO and the vision was the same. It did not change.
MR. WILCOX: That was a most appropriate transition from Marshall to Ralph; you have been by his side for a number of years?
DR. LILLARD: What a teacher, he was! Plus, we just had total trust in one another. We could almost start one sentence and the other could finish it. We totally believed in the guiding principles and what we were doing. It was somewhat seamless, but he was dearly missed. What shoes to fill, it was very difficult. But, the vision remained the same at that time. The facilities, we had a 301 bed hospital at that time. The outpatient Physical Therapy was now a free standing building across the Turnpike, newly built. We had built a regional Cancer Center which was off of New York Avenue.
MR. WILCOX: Were those added in 1996 or close to that time?
DR. LILLARD: The file needs to be looked at….but they were functioning facilities in 1996. The Hospitality House, MRI center, we had four medical office buildings surrounding the hospital campus. I am not sure when the West Mall Medical Park opened but it had to be between 1990 and 1996 because that’s….. May 1, 1996 was when the fourth medical official facility was opened that had the Eye Center, the Orthopedic Center, and the Heart Center.
MR. WILCOX: So the campus was essentially complete when you became President?
DR. LILLARD: Well it was close to being complete. Yes. The medical staff grew from 23/30 when I started in 1964 to 175 on the active medical staff with 35 specialties! The services included Behavioral Medicine, Cardiology, Emergency, Family Birthing Center, Oncology, Pulmonary and Surgery….here’s the point I want to make as a result of the QT process. The underpinning of MMC state of the art equipment and technology is an innovation called “CareTrax”. We trademarked that. It was a process of providing care for specific treatment and diagnosis; this is where the measurement came. In addition to the Run Charts I talked about we had specific treatments and diagnosis that we measured and the physician’s all participated in to reduce the differences in the care that we wanted to standardize that care and we could improve that process. We could increase the patient’s understanding because we involved them in their care. That was great. They knew what they were supposed to do on particular diagnosis on day two, three, four…..what the expectations were and they participated in their care which was different. At the same time we tried to measure that we were lowering the cost. Again going back to the value formula. We could measure quality increases, we could measure patients understanding and satisfaction and we could measure the lowering of cost, that was the value we wanted to leave on the patient, the medical staff and all hospital personnel because we knew that was the key to our success.
MR. WILCOX: You were recognized by the state, I remember going to Nashville with Jeanie as part of the crowd to receive the award?
DR. LILLARD: We began to put together the Governor’s Quality Award Applications, we didn’t win in 1996 but we won in 1997, that is when George Mathews went down to receive that award but those awards don’t come over night, it took all the hospital personnel. We started in 1990 and it took 7 years or so to get that done. The major issues in 1996 centered around the fact that healthcare was changing rapidly. The market place was driving that change. The future as I have pointed out before belonged to those hospitals that could bring value to the customer and the patient. We thought we were doing that. But it was the judgment of the Board, the medical staff leadership and the management, that MMC could only maintain and continuously improve its services to the community over the longest period of time if it became part of a larger system giving it access to more patient volume and became more attractive to managed care contracts. So on September 9, 1996, MMC consolidated with Fort Sanders Alliance to form Covenant Health.
MR. WILCOX: Can you tell a little bit more about that tremendously boiled down statement of such an important change to a different, actually new era for the Hospital?
DR. LILLARD: What we had achieved in terms of being the healthcare leader in the five county market was our ability to attract about 73% of the total five county population – that was the percentage that lived closer to Oak Ridge than to Knoxville – and concurrently the patient’s ability to choose the hospital they wanted to use when they needed care. Well in 1996, it began to be clear that in the future where the patient received their hospital care may or may not be their choice. Particularly with commercial health insurance coverage -- who made the hospital choice was often going to be who paid the hospital bill. For example, if the patient’s employer contracted with a big health insurance provider like Blue Cross, PHP (now Cariten), Humana, or John Deere, that plan would negotiate contracts for specific reimbursement rates with selected area hospitals for that coverage. Then the plans would steer those patients to the hospitals that they had a contract with. As long as patients were making the choice of hospitals, we (MMC) were doing extremely well. When the big insurance companies started making the choices, driving the market and where patients went for care, our future became more uncertain. In our minds the way to maintain full hospital services for our market for the longest period of time would be to consolidate with another hospital so we could attract all those contracts. As it turned out, that vision was correct. We (MMC) lost some of our autonomy in the process because we became a part of a larger system, but we still had all the services intact. If we had stayed by ourselves that was a big question mark, because, if you look around the county, you see most hospitals the size of Methodist was at that time which have stayed independent have had a very hard time maintaining full services, if they had had them.
MR. WILCOX: Did you see that same thing going on all over the country in that period of time, consolidation, partnerships, co-operative agreements?
DR. LILLARD: Yes, in 1996, that was what was happening. We wanted to consolidate with someone that was a match with us in terms of what we called our values and guiding principles to us, who we thought it would be a good match for the medical staff also. That is how that came about.
MR. WILCOX: It was a major move?
DR. LILLARD: Major move. That concluded my tenure here at MMC, 32 years.
MR. WILCOX: Just like Marshall’s, wasn’t he about 32 years.
DR. LILLARD: No, Marshall was here 28 years. I would like to summarize by saying the Board of Directors was a major strength during this period of time and the reason I think, is that they represented the leadership of Oak Ridge. I can remember as being so effective Board Chairmen like Herman Postma, George Jasny, Ken Sommerfeld, Clyde Hopkins, and Bill Manly. What outstanding resources they were and when we looked around at other hospitals in the market place and beyond they had no one with that type of capability on their boards. In terms of major strength, the Board of Directors was a major strength during this time. The second major strength was the medical staff because for the most part the medical staff believed during that period of time that what was best for the hospital was best for them and visa versa. We all felt we needed to succeed together in providing the most value we could to the community and that was just wonderful. We did it from a hospital personnel point of view, through the QT program and other relationships principally because of Marshall and others developing a trust relationship with the employees. They believed in our/their mission and their values and they knew it was bigger than any one person. We could call on each other and call each other out, no matter who it was and say “What you are doing is beyond our vision or our values and we would call each other on it”. We stopped and said, “You’re right, that’s not right.”
MR. WILCOX: You feel it was critically important that you had the support of the medical group and your staff throughout this?….
DR. LILLARD: Yes, absolutely. The management was a team that stayed together for a long period of time. Together we had unity of purpose with a common values; all those things going for us. Not a lot of organizations for that period of time had unity of purpose and if you have unity of purpose you could accomplish some things. I think a lot of things were accomplished. Organizationally they were accomplished. I think they were accomplished from the patient care point of view. In terms of community I think the community had a great asset as I have said before I think the gift that the federal government gave was a gift that became a blessing to the community.
MR. WILCOX: It certainly was, Ralph, and the blessing to the community certainly came about as the result of the commitment you and Marshall had and demonstrated through the leadership that you gave us during the decades of the 60’s, 70’s, 80’s and 90’s. We in the community owe you a great debt of thanks for your leadership and vision which has resulted in the great institution we have in Oak Ridge today. Thank you so very, very much.
DR. LILLARD: My pleasure.
[End of Interview]
2nd revision, 09-20-08 WJW with RL.

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METHODIST MEDICAL CENTER ORAL HISTORY:
DR. RALPH LILLARD
Interviewed by William (Bill) J. Wilcox, Jr.
August 27, 2008
MR. WILCOX: This is Bill Wilcox and it is August 27th, about 10am, and I am interviewing Ralph Lillard who for 32 years was one of the top administrators of the hospital here in Oak Ridge. Ralph has kindly done some good homework preparing for this interview outlining highlights of his years with the hospital. I will attach his notes, and refer to them from time to time as we listen to Ralph this morning. Ralph, thank you so much for coming in to chat. We have completed the release form. You have done a wonderful job of outlining your timeline and key events and I would like to let you go through them and tell us what you can about your times here at the hospital. First Ralph, let me get information about when you came first to the hospital here in Oak Ridge and who hired you and what was your first job when you came?
DR. LILLARD: I’m glad to be here, thank you for the invitation; it represents a significant part of my life’s work, being here at Methodist from 1964 to 1996. I first came to Methodist as an administrative resident from George Washington University, Washington, D.C. on a two year residency and my mentor was ORHMC [Oak Ridge Hospital of the Methodist Church] Administrator Paul Bjork. He was on the mentors list from GW and I selected Oak Ridge because I came from a small town growing up and I looked at that list and saw Oak Ridge was the only small town on the list! So I began to think that I might want to interview here so that’s how I got here.
MR. WILCOX: What was your hometown?
DR. LILLARD: Siloam Springs, Arkansas, a long way’s away. That is how I came, I spent two years being an administrative resident and writing a lot of reports, doing a lot of things, working myself through the rotation of every department of the hospital. One of the special early projects that stick out is the conversion of the old West Mall “D” wing to a nursing home. That was an interesting project.
MR. WILCOX: That was in the mid sixty’s?
DR. LILLARD: I believe it was between 1964 and 1966.
MR. WILCOX: Why did we renovate that wing, the West Mall wing?
DR. LILLARD: Well, the wing was a part of the old “D”-wing of the original hospital, and it was standing idle and the Board, which you may or may not have been a member of then (WJW- I was), decided to convert that wing to a nursing home facility, to be part of the core business of the hospital.
MR. WILCOX: What else do you remember about those years? Were you involved in the big strike 1966?
DR. LILLARD: Yes. I think about these years in five ways (see his attached notes) …..
1. Vision
2. Facility
3. Medical staff
4. Services
5. Major issues
I used this in my notes as the outline of what I remember in various periods (see attached) and certainly some of the dates need to be confirmed by the corporate records. In those early years under Vision I think of three things:
#1. Financial survival. The community received a nice new hospital in 1959, but no cash that went with it and so the survival issue was how you have enough cash flow, pay the payroll, and do things that need to be done to operate a 220+/- bed hospital. It was a significant matter and so the vision under that would be “How do we survive next year?” A lot of time, effort and energy was spent trying to determine that.
#2. To maintain the hospital services for Oak Ridge and part of Anderson County and Roane County. The service area in the mid 1960s was limited to Oak Ridge in terms of vision and our part of two counties, so it was a very limited market.
#3. Secure financing for the Medical Arts building that had been built but not fully completed. I remember making trips to B.C.Zigler Co. in Wisconsin and securing some bonds. Some taxable bonds that we sold and we were lucky to do that in order to pay for the Medical Arts building eventually and also to occupy it all to provide space that the physicians needed desperately.
Under Facility, as I noted, we had a 220 bed general-acute care hospital built by the federal government and given to Oak Ridge in 1959. My recall there were about 23 physicians here when I got here maybe upwards to 30 but no more than 30. The services were those of a general-acute care hospital service and the major issue you just pointed out then was a 51 day labor outage in 1966 with the BSEIU [Building Service Employees International Union].
MR. WILCOX: I was on the Board then and it for sure was the major issue for the Board that year!
DR. LILLARD: It made a lasting impression on me in terms in how you relate to people and develop trust. That lesson was a very fundamental learning that afterward was incorporated in everything we did which we’ll see over the next 30 years. That’s all that period of time, do you want me to run to the next time?
MR. WILCOX: Yes, please do. The next key period of time was what?
DR. LILLARD: 1967, and the reason for that is because that was the year the new administrator came to ORHMC - that’s right, Paul Bjork left, Marshall Whisnant came in. He became not the administrator but the President and CEO, so we changed corporate titles and his vision and mine too. He was the principal person that was, first, to build an organization based on “New Business Principles and Values”: and second, to improve the hospital services and third, to recruit new medical staff members. That was the vision for that period of time.
MR. WILCOX: Grow the medical staff?
DR. LILLARD: Yes, and the hospital services.
MR. WILCOX: How about the service area?
Well, that had not been addressed yet. I’ll get to that, but first we were just trying to replace some of the medical staff that were nearing retirement. We did that and then we tried to improve not only hospital services but to envision what medical staff needs would be. There were no changes in terms of facilities, no major changes in medical staff although the records may reflect there were some, but I’m not going deal with that now. But the second major issue other than recruiting, the new President and CEO was building trust between the management and hospital personnel, trying to heal the many scars were left because of the labor outage.
MR. WILCOX: How about building the support of the community, was that something that you all tackled then or did it come later?
DR. LILLARD: We tackled it every day.
MR. WILCOX: Because there were a lot of scars left in the community?
DR. LILLARD: Absolutely.
MR. WILCOX: As a result of the labor outage?
DR. LILLARD: Yes, there certainly were. There were lots of ways that these issues were addressed; like we went out and became integral parts of various community activities to explain the hospital story and also do work in behalf of the community. We also addressed making sure that the community leaders were on the Hospital Board to bring in every aspect of the community…
MR. WILCOX: You mean diversified the Board from what it had been?
DR. LILLARD: Yes, that is correct, so the policies of running the hospital would be reflected in that diversification.
MR. WILCOX: When I look back, Ralph, I see those years 1967 and shortly then after, as years when we really did change the hospital image in the eyes of the community and the staff of the hospital. I give you and Marshall tremendous credit for that.
DR. LILLARD: Well there was a lot to do because the scarring, started from its inception in the referendum.
MR. WILCOX: It started back then?
DR. LILLARD: There was a scarring there.
MR. WILCOX: It was exacerbated by the strike?
DR. LILLARD: The strike, you are correct and then just the fact that we needed to heal and how we were going to go about doing that was a task that was very significant.
MR. WILCOX: What about the administrative staff in 1967? That time frame? Was the top management primarily you and Marshall?
DR. LILLARD: It was. I can’t remember the Director of Nursing then, I think Frances McCallum may have come and gone. It may have been Guthrie Davidson or Shirley Belvins, one of those two, but I can’t remember…the files will reflect who that was. Certainly, they were a vital part but the next big part to answer your question, the question you had, was the coming and recruitment of a Nurse Executive to manage the Nursing Services. That was the major issue of 1971. We wanted a “world class person” because one of the things that the labor outage reflected was that we needed to put a higher emphasis on quality patient care, and we needed to make sure that nurses had an education program here internally, and we needed greater expertise from the management point of view. We researched the nation and very helpful to that research was the Tennessee Nurses Association (TNA) executive director in Nashville Mrs. Rebecca Culpepper, who suggested some names to me -- and one of those names was Elizabeth Cantwell, who was in New York City.
MR. WILCOX: My goodness. Well, Ralph I have never heard that story. So Betty came from New York?
DR. LILLARD: Yes, Rebecca Culpepper suggested her personally because she had Betty talk on various seminars. Betty worked for the American Nurses Association (ANA) and lived in New York. To make a long story short, we interviewed and Betty decided to come to Oak Ridge, TN. What a blessing that was for our community and for the hospital.
MR. WILCOX: Amen to that! When was this?
DR. LILLARD: Betty’s first day was January 2, 1971.
MR. WILCOX: You still remember?
DR. LILLARD: It was a big day. We celebrated because our vision was that we had to improve the quality of healthcare services at the hospital and we knew that Betty would be an integral part of that. Second thing was at that time we were involved with improving the business processes and the old electronic data processing. Punch cards were flying everywhere and those card sorters were going all night. We were getting bigger, more complex, we needed information on a faster basis and so we were trying to incorporate some efficiencies in how we took care of our business side. The next need in terms of vision was to recruit new physician specialties, which we would continue to do. In 1970/1971, we added some major new facilities. We put in a new first class physical therapy department and brought in Don Russell. His wife Helen Russell was Secretary to Paul Bjork and then to Marshall. Don helped many, many folks and was a highly popular person. But he ran the physical therapy department starting in 1970.
MR. WILCOX: That was a new venture for the hospital?
DR. LILLARD: We had had a Physical Therapy Department, but it was not the modern day updated Physical Therapy Department we wanted to have.
MR. WILCOX: But Don turned that around?
DR. LILLARD: Melvin Overton had been the head of our Physical Therapy Department and he retired. So when he retired we consulted with Don and he helped us facilitate and design the new PT Department and that came online in 1970. Also at that time, there was a new business office, new admitting, new administrative office, and a new dietary department that came on line in 1970. My records show we are still continuing to recruit physicians, but I would just have to go to the files to see who those were.
MR. WILCOX: But the number of physicians continued to successfully increase?
DR. LILLARD: Yes, and I’ll get to the numbers in a little while but in that particular year 1970 we were continually recruiting new physicians always based on need. Now as part of the new services that year 1970, we opened our first Coronary Care Unit (CCU). That was a moment in which the community was proud, we had a big open house and brought in a new clinical specialist we had never had before and indeed our move toward high quality care service was on the road uphill.
MR. WILCOX: Ralph, if I may interrupt, you mentioned Don Russell, and how helpful he was in revitalizing our Physical Therapy Department, but I wonder if you could say another word about Helen Russell before we move on?
DR. LILLARD: Yes, Helen Russell was, the day I came in 1964, one of the first two or three people I met. Helen Russell was the secretary or administrative assistant to Paul Bjork and she took care of me and kept me straight, She knew all the rules and she knew when I was suppose to do this or that and the other in terms of structure. She called me in the morning and she let me know that I was not here on time! Or that I was doing something I didn’t need to be doing. And as time went along she served as my secretary also. But unfortunately Helen had a disabling stroke.
MR. WILCOX: That was tragic, Helen was great lady.
DR. LILLARD: I still to this day see Helen and Don frequently and we just love them. I don’t know what more to say about them.
MR. WILCOX: They are great people. I just wanted to get that on the record that Helen not only nurtured you, but I can attest that she also nurtured the Board. Paul was always very busy, but Helen was the one who could answer my questions.
DR. LILLARD: Absolutely. What a wonderful contribution both Helen and Don Russell made to this hospital. In 1973, I saw no change in the vision and the facilities but the medical staff we had recruited involved some new specialties, one was Dermatology, another was Endocrinology, others were Gastroenterology, Nephrology, Hematology, Oral Surgery, Otolaryngology, Pulmonary, Neurology, and Allergy.
MR. WILCOX: How in the world did you get all those specialists?
DR. LILLARD: We worked at it, day and night, seven days a week. We knew that having the physicians available to serve the patients was the lead strategy for us. If we did not have them, the people folks wanted to have take care of them when they were sick, we would not have a full service hospital. So what we wanted to guarantee the physicians and the patients was that once they got here they would have quality care. It was a good match. New services during that particular year included our contracting for full time physician coverage in the Emergency Department. That was a big thing.
MR. WILCOX: I remember that as a major change.
DR. LILLARD: It was a major thing because we had no money. We fortunately were able to negotiate a contract with Dr. Herschell King and he took the job at risk. The medical staff supported him, and they very much wanted to stop answering calls to go from their homes or offices to the ER. They wanted somebody to fully staff the Emergency Room, a qualified physician so then they could take calls based on his referrals, and they would be called a lot less than if nurses were running ER. Dr. King saw the patient first and took care of them unless it was obvious that someone else was needed.
MR. WILCOX: That was a very different philosophy, isn’t it? Prior to that, a nurse would call each of the specialties?
DR. LILLARD: The nurse would make the initial assessment and call the physician, this was part of our quality initiative. Now a physician would make the initial assessment and call whatever specialist was necessary.
MR. WILCOX: He would take care of a lot of calls that I wouldn’t say were trivial but were of a lower level of need calls?.
DR. LILLARD: Sure, and the patient could be taken care of much more quickly. It was a process of improving the care.
MR. WILCOX: You improved the care of the patients but you also helped the relationships with the medical staff?
DR. LILLARD: It was more than helping a relationship. The physicians had gotten to a point they could not do both. They could not practice their specialty because of the volume and run back and forth to the ER. This was a good thing for all concerned. It was one of those things, Bill, that was a win/win, the patient won, the hospital won, the physician won, it was a good thing. Some of the major issues in 1973 were to determine the need for new beds, for a new Radiology, Surgery and Outpatient facility as well as for new parking capacity. Also we were getting to the point where we needed to recruit a new executive to manage our financial services. As you note on the chart we accomplished that by finding and hiring someone who knew the hospital well (he was born in the hospital!) Richard Stooksbury. We knew him because he was with Ernst & Ernst, a major accounting firm and our hospital auditor. He was the primary person responsible for our audits and we knew he knew the hospital well. He was a man of integrity and he was very bright person. We were successful in recruiting him, and what an advantage we had then at the hospital because he was an outstanding person. The next year I would like to look at is 1976 and the principal focus then was on facilities. The vision stayed the same and the medical staff. I’m not going to address the staff or the services, but as to facilities we completed our study, and decided now we had to provide additional facilities because our volume was increasing so we added a new patient care wing in 1976. It had four floors and when it opened, we had around 268 beds.
MR. WILCOX: Ralph, could I ask you how in the world did we pay for that?
DR. LILLARD: The new beds?
MR. WILCOX: Yes.
DR. LILLARD: We sold bonds.
MR. WILCOX: Again?
DR. LILLARD: Well the first time through B.C.Zigler they were taxable bonds. I need to be checked on this but I am fairly certain that these last ones were tax free bonds sold through the Health and Education Board.
MR. WILCOX: And the State?
DR. LILLARD: Yes, that is correct. At that time there was a Health & Education Board both in Oak Ridge and one in the county. I believe these were done through the Anderson County Health & Education Board. Patients from our own service area pretty much bought the bonds which was good for us because they then had a stake in the success of the hospital.
MR. WILCOX: Another win/win?
DR. LILLARD: Yes, the interesting thing about the new beds in the General Care wing was that they utilized a new concept of “decentralized nursing.” We did a nation-wide study and decided we wanted to do this new concept, the reason was that everything would then be closer to the patient. The chart would be in the patient’s room, the principal sterile supplies would be in the patient’s room, so the nurse would be traveling to the patient as well as the doctor would be making rounds as opposed to everybody centralized in one nursing station. It was a different concept, a very, very significant change at the time.
MR. WILCOX: Did the staff buy into it?
DR. LILLARD: It was a struggle. We had great clinical leaders led by Ms. Betty Cantwell, who really believed that the patient care would improve in that way. There was some resistance as is with every change, but over time it got to be something that many others came to look at and copied over the country.
MR. WILCOX: Knoxville too?
DR. LILLARD: Not sure Knoxville, but many places in the country did. The ground floor of this facility change included Intensive Care, Coronary Care, Surgery, Recovery Room and Emergency Room. That too was a significant change for us. Then we began to think about a major issue in 1976, “What is the new mission and vision; what should it be for Methodist?” In 1984, the next date I would like to consider because it was then that we came forward with what the new vision was –“To be the leader in meeting the healthcare needs of all the people in our region.” That bigger region was Anderson, Roane, Morgan, Campbell and Scott counties which was approximately 185,000 people.
MR. WILCOX: Was that a new concept at that time, the mission, was that the time when we expanded the service area?
DR. LILLARD: Yes it was. I noted initially that Oak Ridge Hospital was focused on Oak Ridge and part of Roane and part of Anderson Counties, that was the market. That was the service area.
MR. WILCOX: Really a local hospital?
DR. LILLARD: Really local. As time went on, we began to implement the vision and it came forward officially and approved by the Board in 1984 that we wanted to be the leader of a 5-county market.
MR. WILCOX: Were there objections to this taking of the 5-county market by other area hospitals?
DR. LILLARD: Sure, but you know we were competing against ourselves in terms of getting better. We were not necessarily competing against other people. We just wanted to get better. I’ve got a quote here from Marshall Whisnant relative to that fact. Marshall said, “Patients were having to drive past Oak Ridge for healthcare offered only in Knoxville. They wanted more healthcare options closer to home”. We determined it was our mission to provide those options. So that was what we were doing. So in 1985 was the next benchmark that I have. Then our focus was not on Vision because we just established that, or on Facilities, but at that time on the Medical Staff. At that time we were recruiting a lot of family practitioners because we found out that in order to “feed” all these specialists there needs to a strong primary care base. So we formed a couple of groups, one in 1985 and one in 1986. In 1985 we formed “East Tennessee Family Clinics,” and that was where we tried to provide support to family practitioners by way of office management, by way of recruiting, and by other things that would make their practice more successful. We gave them databases so they could do their own quality assurance within their practices, and we became, in effect, a very supportive alliance with the family practitioners.
MR. WILCOX: You said very clearly, clinics, plural. I know about one family clinic here in Oak Ridge, Where were the others?
DR. LILLARD: The second one if I recall correctly was in Clinton and the next one was in Powell and the next one I believe was in Lake City or Oliver Springs, then one in Morgan County. So we had many clinics. Now the clinics I talked about were not only those built in 1985, but there were a progression over time – all of them under East Tennessee Family Clinics. In addition to that we formed another company called Tennessee Medical Management in 1986 and that was to provide similar services to people outside our market. At that time, the Norris Family Clinic was outside our market and we related to them in a different way. They came under the TMM model, so that we would want the McNeeley’s (the father and the two sons at the time) to refer to our specialists if at all possible, so we helped them with their practices -- but they had a choice, we didn’t mandate anything -- they had the choice to refer anywhere they wanted to.
MR. WILCOX: But you gave them great support?
DR. LILLARD: We gave them great support so that it made it easy for them to refer to us and to our specialists. If they choose to do that, it was good. In terms of major issues for 1985, we needed to provide both CV Surgery and Neurosurgery for what we then called the circle of care to be complete.
MR. WILCOX: CV?
DR. LILLARD: I am sorry, cardiovascular surgery and neurosurgery, because we wanted the circle of care, we called it at that time, to be complete – that’s when you could get everything at Oak Ridge that you could go to Knoxville and get. We had equal to or better services. That’s what we called completing the Circle of Care. We successfully recruited those in 1990. Let me back up to pick up a very important event in 1985. We recruited a COO to manage the hospital on a day to day basis, and he was George Matthews.
MR. WILCOX: Was this because you were now getting so involved in the regional work?
DR. LILLARD: We became regional so that we evolved into the Methodist Healthcare System and we had two divisions. One division was a for-profit division which had things like Healthcom under it. Under Healthcom was real estate and Outpatient services other than on the Methodist campus and then it had TMM, which we described a while ago and we had a relationship, a half ownership/relationship in an insurance company with Ft. Sanders called PHP. Those were taxable. The not-for-profit was MMC, the hospital and the hospital foundation and we had two divisions and so we had a holding company that sits on top and that was how that went.
MR. WILCOX: Ralph, you just mentioned the word foundation, do you remember why or when that started?
DR. LILLARD: No, I would have to go to the files to see. I do know, it started initially because we had some significant gifts that we ran through the hospital and that was fine since we were a 501(c)3 organization. It worked fine. One of the gifts was from Paul Spray, Paul and Louise Spray, someone that we all know and love, but we had some other great, nice gifts too and we decided we needed somebody to focus on getting more of that kind of giving. They just came because people believed in us and they just came about. We decided to put some focus on it and we did form a foundation and ….
MR. WILCOX: This would have been roughly in the 1995 or so??
DR. LILLARD: I am guessing 1990, but I am not positive.
MR. WILCOX: Who was the first foundation director?
DR. LILLARD: The first Director was Ken Menifee. He grew up in Oak Ridge and his family lived here,
MR. WILCOX: You were telling about this new recruiting of the new COO.
DR. LILLARD: Yes, that was George Matthews.
MR. WILCOX: I remember George’s coming then just as an Oak Ridge citizen reading the newspaper. I read that you were hiring a COO but didn’t really appreciate until your nice description, that his hiring was because the top management, you, Marshall, Stooksbury, were pretty well so absorbed with lots of ventures outside Oak Ridge, the regional impact that the hospital had?
DR. LILLARD: We were concerned with the strategy. Excuse me, let me back up, we were concerned about the vision, the mission, the values, the culture and how we strategically implemented those in the organization.
MR. WILCOX: But at the same time you were very concerned to make sure about patient care?
DR. LILLARD: The core hospital, day-to-day operations needed professional attention and we brought in George Matthews. What a wonderful find that was for us. I had known George for a long time.
MR. WILCOX: Had he come from within the system here?
DR. LILLARD: I knew him initially at Baptist in Knoxville. He left Baptist in Knoxville and went to ParkWest and then he went to UT-Martin in Martin, Tennessee, an HCA [Hospital Corporation of America] hospital. Anyway we were keeping up with him, he was a wonderful man, good values, good match for us, so we made contact with George and to make a long story short he came in 1985 and had a wonderful career here at Methodist. In 1990 the vision was that in addition to being the Healthcare leader, Methodist should also provide high quality, low cost care that could be measured, not just saying we had it, but we wanted to measure it.
MR. WILCOX: Metrics?
DR. LILLARD: Yes, for the people in the five county area. I’ll show you in a minute how that played out. But that was the vision. We wanted to be able to do that. The value desired at that time was improving the quality (measured), improving the service (measured), and lowering the cost at the same time. You improve the quality, you improve the service, and you lower the cost concurrently. That was our definition of value. Facility-wise, a new CV and new neurosurgery suites were completed in 1988 to 1990 time frame. The new fifth floor to the Patient Care services was completed as well as Administrative Business offices, Outpatient Services and we renovated the dietary, the lab and the pharmacy.
MR. WILCOX: Major renovations?
DR. LILLARD: Yes and the new hospital physician’s office building which was called Physicians Plaza was built and the interesting part about that, we talked about real estate earlier. We had been buying real estate through another entity for the last three or four years. Such Oak Ridge “landmarks” as the Snow White, Kittrell’s paint, and Mill’s florist were part of that as well as Dr. J. D. Johnson and the dental office and some other people. We quietly bought them over time and tore them down so we could turn the hospital front door around to face the Turnpike in 1990. When we opened these new facilities the hospital could be accessed from the Oak Ridge Turnpike as opposed to just Tennessee Avenue, a major change. That was a major change in our image.
MR. WILCOX: But you said “quietly” Ralph, weren’t there some people who didn’t like the destruction of the “priceless” Snow White - not a very quiet operation?
DR. LILLARD: I could tell you some stories, but that was an interesting time.
MR. WILCOX: Of course Oak Ridgers’ love to express themselves and didn’t hesitate… how about Cheyenne and Charlotte Hall, was that later?
DR. LILLARD: Yes, much later. The medical staff we were successful in recruiting CV and neurosurgeons and that was great. In terms of services, we did implement those two new services. That was a big thing and a whole different story about cardiovascular surgery and how that all came about. Baptist of Knoxville mentored us and we did parallel services with them for a while for six months before we were weaned away. They were very helpful to helping us get CV services here and in a quality way. We also started the process to implement a total quality approach to management based on W. Edwards Deming’s philosophy.
MR. WILCOX: What drove that?
DR. LILLARD: What?
MR. WILCOX: The idea of trying Deming’s philosophy of quality, quality control management.
DR. LILLARD: We called that process Quality Together (QT), we had used Management by Objectives for all these years. We had been going around and watching other, what we considered to be better performers than we, across the country and they had some processes that we did not have. There was a local firm here in Knoxville (WJW-Qual-Pro on Pellissippi Parkway) whose leader was one of the Deming disciples. We the Board and the management and the medical staff leadership decided to take a week off and go and listen to that disciple and let him let us know all about Deming. We came home and made a commitment that that was what we were going to do here. Because we felt like in terms of quality and terms of measuring our quality we didn’t know how to do it unless we went this direction.
MR. WILCOX: I am fascinated by the fact that you and Marshall and the others were looking at other hospitals in the country trying to see if there were “best practices” somewhere else that could be instituted here. Who on the management team was really doing this looking at the other hospitals. Was it you or Marshall or. . .?
DR. LILLARD: Marshall was the lead person in that. He would identify some areas and then depending on the area identified decided who went to follow up. If it was a financial area or if it was business efficiency, Richard Stooksbury went. If it was Nursing, Betty and some of the clinical specialists went. If it was organizational, I was the guy that had to implement those things. But in terms of Quality Together it was all of us. We stopped and we decided to learn together.
MR. WILCOX: The team went together?
DR. LILLARD: Even including the Board because unless the Board was completely understanding and if it isn’t from the top down it will not work.
MR. WILCOX: One other question I had…. You mentioned the new Physicians Plaza building which of course the community saw, all we saw from the outside was a major building addition. Was that primarily a tool to help in your recruitment of other new physicians or was it a service that provided space for the physicians we already had?
DR. LILLARD: Both. Those were the primary reasons, but there was another reason, that was image. We wanted our image to change. The image we wanted was that of a Medical Center, a Regional Medical Center, not just a local hospital. It looked different, we began to put together a campus, and the campus now extended from New York Avenue (which I know some great friends that live on New York Avenue. Right, Bill). So it is extended from New York Avenue all the way (east) up to past the Ridgeview Mental Health Center. Major issues in 1990 was to apply the QT process throughout the organization, the Board of Directors, the medical staff, and all hospital personnel, and that required a culture change. That was a significant process that we did.
MR. WILCOX: A culture change?
DR. LILLARD: It took several years to accomplish. In addition to that, Betty Cantwell retired in 1990. What a contribution and what a lady she was!
MR. WILCOX: Ralph, if you will hold on just a minute I have to change my tape. OK, I have turned the tape.
DR. LILLARD: I want to talk a little bit about the guiding principles of the QT program because our mission statement as you know stayed the same. That was, we wanted to be the leader in meeting the healthcare needs of all people in our region, the five counties. But once we embarked upon the QT program -- not program, excuse me – the Quality Together process, we needed some guiding principles and we went through the organization and we looked at it from inside out and we had lots of sessions with lots of employees and we say, what is at our “core.” What really drives us? What really will bring trust and a unity of purpose to us? We settled on four things. One was a quality policy; we wanted quality care and products. Next one was a service policy; because we wanted to satisfy the customer. The third one was a people policy -- we wanted to promote teamwork and mutual trust. The last one was a resource policy; one that allocated all of our resources wisely. Those were the guiding principles of the “Quality Together” effort.
MR. WILCOX: Ralph, when you say quality together and “QT” process I used to hear so often about QC so for the transcriber I want to be sure we are talking QT. Quality Together what does that mean?
DR. LILLARD: That means all of us in this organization from the Board, every employee, all of us are unified in how we were going to approach our work. We were going to utilize these four guiding principles to do that. We were going to not just do it but measure it so we know we’ve done it - and that’s what we set out to do.
MR. WILCOX: Was that a hard sell for the staff? How long did it take?
DR. LILLARD: It wasn’t an authoritative commitment. It was an appeal in which we reached out to the people, because the people felt the excitement of what Methodist was doing. People, including the board, the medical staff and all the personnel all felt we needed to do something that unified us that we could totally have faith in one another to bring us up to the next level. I used to, not only I but Marshall and the whole team, used to go around and one of the measurements was that we could say that 85% of the people (employees) that we could just randomly walk in and ask them what the mission, the vision and the guiding principles at Methodist was, we would get an 85% plus response. They knew, they would rattle it off. Eventually that changed the culture because that was who we were and that was how we thought. That is how we measured our performance. When you go down to the Dietary Department and you see the guy washing the pots and pans has a process quality “Run Chart” on top of his pot sink, it feels good because you could not have that without educating the people on the process. When the pot washer knows how to do a “Run Chart” (displays process performance over time), it makes everyone feel good because we know the employee has been given the “tools” not only to measure his own work but also to continually improve it. 1995 was the next benchmark I would like to look at. The vision was the same, the facilities were basically the same but the medical staff in 1993, the family practice physicians, there were about 25 of them who became “office based.” They decided….
MR. WILCOX: What does that mean?
DR. LILLARD: It meant they didn’t want to go to the Emergency Room anymore or admit patients to and care for them in the hospital. Either one. We had so many family practice physicians in so many different locations, which I defined earlier. It was very difficult for them in Norris, in Oliver Springs, Morgan County and Powell to come and attend their patients in the Emergency Room so we had full time Emergency Room physicians, but then when it came time for admission to the hospital for primary care that became a big problem. The same thing again happened that happened back when we got Emergency Room physicians so we formed this new group of physicians called Methodist Medical Group (MMG). It still exists today, where we have full time physicians in the hospital who admit and take care of folks in the hospital. That was the major thing in 1993.
MR. WILCOX: Wasn’t Dr. Richard Dew one of the first ones?
DR. LILLARD: Yes, he was. Richard Dew was one of the point people, he and Dr. Garton were the two people that implemented that. You know if we had not had a close working relationship with the physicians that would have been difficult to do but as it turned out the medical staff in general was very supportive of this move. The hospital was very supportive of it. We engaged “Team Health” who ran our Emergency Department at that time, John Mincy, M.D. was president or the person who looked after the Emergency Department. It was an extension of our Emergency Department and it worked extremely well.
MR. WILCOX: As I remember it though from the stand point of the patient it was sort of a bummer to not have my own doctor attending me when I had to go to the hospital as a patient and have to meet a brand new person.
DR. LILLARD: That was resolved over time. Any change…any time you make a change like that communication helps. In the doctor’s office when they began to tell all their patients how this process worked, it helped. And here’s how it worked. The patient presents themselves in the doctor’s office at which time he would tell them if they needed admission and he would make arrangements, or he’d let us know that within 24 hours of that time they were to be admitted to the hospital. Then the family doc would get a progress sheet faxed back to his office so there was no competition between the MMG hospital doc’s and the referring doc’s because MMG doc’s saw no office-based patients. So all the medical issues they found in MMC, how their treatment went, the outcomes, and how they needed to be followed up was all sent back immediately so it could be incorporated in their chart in the home physician’s office. All that got done and over time the patient saw it was a “hand and glove process.” The major issue in 1995 was that Marshall Whisnant retired and it created the need to recruit or appoint a new president/CEO and as it turned out, I was the person the Board decided to hire. In 1996, I did become the president and CEO and the vision was the same. It did not change.
MR. WILCOX: That was a most appropriate transition from Marshall to Ralph; you have been by his side for a number of years?
DR. LILLARD: What a teacher, he was! Plus, we just had total trust in one another. We could almost start one sentence and the other could finish it. We totally believed in the guiding principles and what we were doing. It was somewhat seamless, but he was dearly missed. What shoes to fill, it was very difficult. But, the vision remained the same at that time. The facilities, we had a 301 bed hospital at that time. The outpatient Physical Therapy was now a free standing building across the Turnpike, newly built. We had built a regional Cancer Center which was off of New York Avenue.
MR. WILCOX: Were those added in 1996 or close to that time?
DR. LILLARD: The file needs to be looked at….but they were functioning facilities in 1996. The Hospitality House, MRI center, we had four medical office buildings surrounding the hospital campus. I am not sure when the West Mall Medical Park opened but it had to be between 1990 and 1996 because that’s….. May 1, 1996 was when the fourth medical official facility was opened that had the Eye Center, the Orthopedic Center, and the Heart Center.
MR. WILCOX: So the campus was essentially complete when you became President?
DR. LILLARD: Well it was close to being complete. Yes. The medical staff grew from 23/30 when I started in 1964 to 175 on the active medical staff with 35 specialties! The services included Behavioral Medicine, Cardiology, Emergency, Family Birthing Center, Oncology, Pulmonary and Surgery….here’s the point I want to make as a result of the QT process. The underpinning of MMC state of the art equipment and technology is an innovation called “CareTrax”. We trademarked that. It was a process of providing care for specific treatment and diagnosis; this is where the measurement came. In addition to the Run Charts I talked about we had specific treatments and diagnosis that we measured and the physician’s all participated in to reduce the differences in the care that we wanted to standardize that care and we could improve that process. We could increase the patient’s understanding because we involved them in their care. That was great. They knew what they were supposed to do on particular diagnosis on day two, three, four…..what the expectations were and they participated in their care which was different. At the same time we tried to measure that we were lowering the cost. Again going back to the value formula. We could measure quality increases, we could measure patients understanding and satisfaction and we could measure the lowering of cost, that was the value we wanted to leave on the patient, the medical staff and all hospital personnel because we knew that was the key to our success.
MR. WILCOX: You were recognized by the state, I remember going to Nashville with Jeanie as part of the crowd to receive the award?
DR. LILLARD: We began to put together the Governor’s Quality Award Applications, we didn’t win in 1996 but we won in 1997, that is when George Mathews went down to receive that award but those awards don’t come over night, it took all the hospital personnel. We started in 1990 and it took 7 years or so to get that done. The major issues in 1996 centered around the fact that healthcare was changing rapidly. The market place was driving that change. The future as I have pointed out before belonged to those hospitals that could bring value to the customer and the patient. We thought we were doing that. But it was the judgment of the Board, the medical staff leadership and the management, that MMC could only maintain and continuously improve its services to the community over the longest period of time if it became part of a larger system giving it access to more patient volume and became more attractive to managed care contracts. So on September 9, 1996, MMC consolidated with Fort Sanders Alliance to form Covenant Health.
MR. WILCOX: Can you tell a little bit more about that tremendously boiled down statement of such an important change to a different, actually new era for the Hospital?
DR. LILLARD: What we had achieved in terms of being the healthcare leader in the five county market was our ability to attract about 73% of the total five county population – that was the percentage that lived closer to Oak Ridge than to Knoxville – and concurrently the patient’s ability to choose the hospital they wanted to use when they needed care. Well in 1996, it began to be clear that in the future where the patient received their hospital care may or may not be their choice. Particularly with commercial health insurance coverage -- who made the hospital choice was often going to be who paid the hospital bill. For example, if the patient’s employer contracted with a big health insurance provider like Blue Cross, PHP (now Cariten), Humana, or John Deere, that plan would negotiate contracts for specific reimbursement rates with selected area hospitals for that coverage. Then the plans would steer those patients to the hospitals that they had a contract with. As long as patients were making the choice of hospitals, we (MMC) were doing extremely well. When the big insurance companies started making the choices, driving the market and where patients went for care, our future became more uncertain. In our minds the way to maintain full hospital services for our market for the longest period of time would be to consolidate with another hospital so we could attract all those contracts. As it turned out, that vision was correct. We (MMC) lost some of our autonomy in the process because we became a part of a larger system, but we still had all the services intact. If we had stayed by ourselves that was a big question mark, because, if you look around the county, you see most hospitals the size of Methodist was at that time which have stayed independent have had a very hard time maintaining full services, if they had had them.
MR. WILCOX: Did you see that same thing going on all over the country in that period of time, consolidation, partnerships, co-operative agreements?
DR. LILLARD: Yes, in 1996, that was what was happening. We wanted to consolidate with someone that was a match with us in terms of what we called our values and guiding principles to us, who we thought it would be a good match for the medical staff also. That is how that came about.
MR. WILCOX: It was a major move?
DR. LILLARD: Major move. That concluded my tenure here at MMC, 32 years.
MR. WILCOX: Just like Marshall’s, wasn’t he about 32 years.
DR. LILLARD: No, Marshall was here 28 years. I would like to summarize by saying the Board of Directors was a major strength during this period of time and the reason I think, is that they represented the leadership of Oak Ridge. I can remember as being so effective Board Chairmen like Herman Postma, George Jasny, Ken Sommerfeld, Clyde Hopkins, and Bill Manly. What outstanding resources they were and when we looked around at other hospitals in the market place and beyond they had no one with that type of capability on their boards. In terms of major strength, the Board of Directors was a major strength during this time. The second major strength was the medical staff because for the most part the medical staff believed during that period of time that what was best for the hospital was best for them and visa versa. We all felt we needed to succeed together in providing the most value we could to the community and that was just wonderful. We did it from a hospital personnel point of view, through the QT program and other relationships principally because of Marshall and others developing a trust relationship with the employees. They believed in our/their mission and their values and they knew it was bigger than any one person. We could call on each other and call each other out, no matter who it was and say “What you are doing is beyond our vision or our values and we would call each other on it”. We stopped and said, “You’re right, that’s not right.”
MR. WILCOX: You feel it was critically important that you had the support of the medical group and your staff throughout this?….
DR. LILLARD: Yes, absolutely. The management was a team that stayed together for a long period of time. Together we had unity of purpose with a common values; all those things going for us. Not a lot of organizations for that period of time had unity of purpose and if you have unity of purpose you could accomplish some things. I think a lot of things were accomplished. Organizationally they were accomplished. I think they were accomplished from the patient care point of view. In terms of community I think the community had a great asset as I have said before I think the gift that the federal government gave was a gift that became a blessing to the community.
MR. WILCOX: It certainly was, Ralph, and the blessing to the community certainly came about as the result of the commitment you and Marshall had and demonstrated through the leadership that you gave us during the decades of the 60’s, 70’s, 80’s and 90’s. We in the community owe you a great debt of thanks for your leadership and vision which has resulted in the great institution we have in Oak Ridge today. Thank you so very, very much.
DR. LILLARD: My pleasure.
[End of Interview]
2nd revision, 09-20-08 WJW with RL.